{
  "abstract": "Background: Adverse childhood experiences (ACEs) are established correlates of suicidality, but their joint associations with cumulative lifestyle-related risks during emerging adulthood and the conditional connections among specific indicators remain insufficiently characterized.\n\nMethods: A cross-sectional survey was conducted among 18,723 college students selected through multistage cluster sampling from six colleges in Shaanxi Province, China. Thirteen ACE domains were assessed using the Adverse Childhood Experiences International Questionnaire. A cumulative lifestyle-related risk score included smoking, drinking, inadequate physical activity, unhealthy body mass index, and unhealthy diet. Suicidal ideation (SI) and suicide attempt (SA) during the past 12 months were self-reported. Modified Poisson regression was used to estimate adjusted prevalence ratios ( aPRs ). Departure from additivity on the prevalence-ratio scale was evaluated using the relative excess risk due to interaction ( RERI ) and attributable proportion ( AP ). Exploratory network models were used to characterize conditional associations and cross-community connectivity.\n\nResults: The prevalence of SI and SA was 3.3 and 1.9% during the past 12 months, respectively. Greater ACE exposure and higher cumulative lifestyle-related risk score were associated with a higher prevalence of both outcomes. Compared with participants reporting 0–3 ACEs and 0–1 lifestyle-related risk factors, those reporting ≥4 ACEs and ≥2 lifestyle-related risks had the highest adjusted prevalence ratios of SI ( aPR , 8.37; 95% CI , 5.64–11.10) and SA ( aPR , 10.30; 95% CI, 5.76–14.85). Positive departure from additivity was observed for SI ( RERI , 3.35; 95% CI , 1.03–5.97; AP , 0.40; 95% CI , 0.13–0.62) and SA ( RERI , 5.18; 95% CI , 1.92–9.78; AP , 0.50; 95% CI , 0.19–0.75). In the exploratory networks, poor sleep showed high cross-community connectivity, while emotional abuse, bullying, inadequate physical activity, and drinking also showed prominent bridge expected influence.\n\nConclusion: Greater ACE exposure and cumulative lifestyle-related risks were separately and jointly associated with a higher prevalence of SI and SA. Participants reporting both ≥ 4 ACEs and ≥2 lifestyle-related risk profiles had the highest prevalence for SI and SA with evidence of additive interactions. The network results describe cross-sectional conditional associations and should be regarded as hypothesis-generating rather than as evidence of causal or mediating pathways.",
  "abstract_shown": true,
  "affiliations": [
    "School of General Medicine Xi’an Medical University",
    "Shaanxi Provincial Health Industry Association Service Center",
    "Shaanxi Medical Association",
    "Department of Psychiatry, Xijing Hospital, Air Force Medical University",
    "Department of Maternal and Child Health, Xiangya School of Public Health, Central South University"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 7,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Xue Wang"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Lei Zhang"
    },
    {
      "affs": [
        2
      ],
      "name": "Zhe Wang"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Xiaoxiao Yuan"
    },
    {
      "affs": [
        3
      ],
      "name": "Huaning Wang"
    },
    {
      "affs": [
        4
      ],
      "name": "Mingyang Wu"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Wenhua Wang"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/615702wwja17r.bib",
  "cited_by": 0,
  "doi": "10.3389/fpubh.2026.1978715",
  "fulltext_url": "https://www.frontiersin.org/articles/10.3389/fpubh.2026.1978715/full",
  "id": "615702wwja17r",
  "issns": [
    "2296-2565"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fpubh.2026.1978715/full",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "lcc",
      "RA1-1270"
    ],
    [
      "openalex",
      "3203|Suicide and Self-Harm Studies"
    ]
  ],
  "openalex": "W7223287559",
  "pdf_url": "https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2026.1978715/pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-23",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/615702wwja17r.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:24Z",
      "native_id": "10.3389/fpubh.2026.1978715",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fpubh.2026.1978715/full"
    },
    {
      "first_seen": "2026-10-30T13:44:10Z",
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:3203|Suicide and Self-Harm Studies",
      "subfield": "psychiatry"
    }
  ],
  "title": "Adverse childhood experiences, lifestyle-related risks, and suicidal ideation and suicide attempts among Chinese college students: joint associations and exploratory network analysis",
  "title_text": "Adverse childhood experiences, lifestyle-related risks, and suicidal ideation and suicide attempts among Chinese college students: joint associations and exploratory network analysis",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T13:44:10Z",
  "url": "https://research.draconitic.com/paper/615702wwja17r",
  "venue": "Frontiers in Public Health",
  "versions": []
}